CO-DESIGNING A STAGE 1B FEASIBILITY STUDY OF INPATIENT PALLIATIVE COMMUNITY HEALTH WORKER SUPPORT

Abstract Persons living with dementia (PLWD) are 2-3 times more likely than their non-dementia peers to be hospitalized annually and experience burdensome care transitions and treatments at the late stage of dementia. Minoritized PLWDs are significantly more likely to be hospitalized and experience frequent transitions between care settings, and also less likely to access palliative care. There is a pressing need to develop better models of care transition support for PLWDs and their family caregivers. Proactive palliative care can reduce unnecessary hospitalization and improve outcomes for PLWDs and family caregivers. Community health workers (CHW) can effectively bridge cultural gaps between vulnerable patients/families and formal care systems, and provide care navigation and coaching support. We are currently conducting a single-site randomized controlled pilot trial study to co-design with key stakeholders (Stage 1a), implement and assess (Stage 1b) the acceptability and feasibility of a palliative CHW support for hospitalized PLWDs and caregivers. To date, we have conducted a needs assessment with 34 PLWD/caregiver dyads, key informant interviews with 4 palliative care providers and 2 CHW and social care experts, and multiple stakeholder meetings with hospital frontline providers and CHW groups to develop intervention components and research implementation plans that address language and cultural barriers and healthcare provider and system level barriers experienced by PLWD and caregivers from minoritized and financially vulnerable backgrounds. In this presentation, we will describe stakeholder engagement and co-design process outcomes and preliminary findings on intervention fidelity, participant recruitment and retention, and PLWD/caregiver outcomes.

Objectives.During the COVID-19, older immigrants in low resource areas who are already excluded from much of social life, had to distance themselves even further, deepening their social isolation.Lack of stimulation can be particularly detrimental, as it influences mood and increases loneliness.Selected for cost-effectiveness and interactive features, we introduced the Companion Robot (CR) system.Preliminary studies conducted in South Korea found statistically significant improvement in quality of sleep and cognition among low-income older patients living alone with multiple chronic conditions and cognitive impairment.Method.Thirty CRs were deployed to solo-living Korean American older adults.We followed up with them after 3 months.In this Stage 1A clinical trial, we tested feasibility, usability and acceptability of CRs, investigating which features of CRs will help improve health behaviors such as medication adherence and daily exercises.Robotic Social Attitude (RoSAS) are assessed with a generic 18-items questionnaire (Krägeloh et al., 2019).
Results.The primary clinical outcomes measured at preand post-intervention were medication adherence and reduction of depression, social isolation and disabilities.The user-friendly doll-shaped design of CRs helped participants feel comfortable interacting with the CR on their own.Exposure to individualized CR-delivered content, including quizzes for brain training and inspirational messages, combined with consistent interaction with CR appeared to be beneficial for cognitive function.
Discussion.Since very few participants had reported diagnosis of dementia, we need to screen for undetected dementia using the Modified Mini-Mental Status Exam.The next stage is to implement further cultural adaptation for the U.S. participants.

CO-DESIGNING A STAGE 1B FEASIBILITY STUDY OF INPATIENT PALLIATIVE COMMUNITY HEALTH WORKER SUPPORT
Jung Kwak 1 , Elizabeth Kvale 2 , Sarah Mills 3 , and Snehal Patel 3 , 1. University of Texas at Austin, Austin, Texas, United States, 2. Baylor College of Medicine,Houston,Texas,United States,3. UT Austin Dell Medical School,Austin,Texas,United States Persons living with dementia (PLWD) are 2-3 times more likely than their non-dementia peers to be hospitalized annually and experience burdensome care transitions and treatments at the late stage of dementia.Minoritized PLWDs are significantly more likely to be hospitalized and experience frequent transitions between care settings, and also less likely to access palliative care.There is a pressing need to develop better models of care transition support for PLWDs and their family caregivers.Proactive palliative care can reduce unnecessary hospitalization and improve outcomes for PLWDs and family caregivers.Community health workers (CHW) can effectively bridge cultural gaps between vulnerable patients/families and formal care systems, and provide care navigation and coaching support.We are currently conducting a single-site randomized controlled pilot trial study to co-design with key stakeholders (Stage 1a), implement and assess (Stage 1b) the acceptability and feasibility of a palliative CHW support for hospitalized PLWDs and caregivers.To date, we have conducted a needs assessment with mentorship, a relationship-centered person-to-person approach may reduce healthcare decision-making burden among African American caregivers through cultural tailoring by promoting oral traditions, personal contact, and storytelling.The purpose of this Stage 1 intervention study is to use a stakeholder-informed approach in further developing and pilot testing the co-created Peer Support for Caregivers of African Americans Living with Alzheimer's Disease and Related Dementias (Pair2Care), a culturally sensitive caregiver peer support program.Pair2Care feasibility and acceptability will be evaluated in current (n=15) and trained former (n=15) African American Alzheimer's and related dementia caregivers.Pair2Care will be deemed feasible and acceptable by evaluating eligibility criteria, recruitment and retention data, protocol adherence, satisfaction, and feedback on program appropriateness for broader dissemination.Preliminary intervention outcomes of caregiver anxiety, depression, quality-of-life, social support, self-efficacy for surrogate decision-making, and intent to use palliative care or hospice services will be assessed to evaluate intervention effectiveness.At 6 months as compared to baseline, current caregivers will report less anxiety and depression, improved quality-of-life, social support, and self-efficacy for surrogate decision-making, as well as intent to use palliative care or hospice services as part of healthcare and advance care planning decision-making.Pair2Care poses an innovative strategy with the potential to address advance care planning and healthcare decision-making, a significant health disparity problem and thereby promote health equity.

EMPOWERING PEOPLE OF ALL AGES BY PROMOTING POSITIVE VIEWS OF AGING AMONG PK-12 STUDENTS
Chair: Tina Newsham Discussant: Lisa Borrero Beliefs about aging and older adults form early in life and persist.People who hold positive views of aging rather than internalized ageism live, on average, 7.5 years longer.Communities where older adults retain meaningful engagement and are respected experience greater longevity and better social and physical well-being among people of all ages.Having positive interactions with older adults increases likelihood of pursuing careers working with older people.Promoting positive, accurate views of aging benefits individuals (of all ages) but is most effective when implemented early in life.Children, however, are rarely intentionally taught about aging and learn primarily negative stereotypes through media such as cartoons, books, and fairy tales.In this symposium, presenters will share projects aimed at disrupting the perpetuation of ageist stereotypes through intentional work with young children to promote positive views of aging.Laura Donorfio will present an aging education project developed for the Connecticut school system via an Administration on Aging grant.Next, Elizabeth Bergman will present two intergenerational case study projects involving elementary school-aged children, college students, and elders.Edward Miller will then the describe and sharing findings from an ongoing intergenerational tutoring intervention, begun during the early stages of the COVID-19